Healthcare Provider Details

I. General information

NPI: 1952592842
Provider Name (Legal Business Name): ASSOCIATED EYE CARE OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 TOWER DR W STE 100
STILLWATER MN
55082-7512
US

IV. Provider business mailing address

1719 TOWER DR W STE 100
STILLWATER MN
55082-7512
US

V. Phone/Fax

Practice location:
  • Phone: 651-275-3050
  • Fax: 651-275-3027
Mailing address:
  • Phone: 651-275-3050
  • Fax: 651-275-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN S LANE
Title or Position: OWNER
Credential: M.D.
Phone: 651-275-3000